An on-line virtual patient simulation called GP Sim, designed to help GPs learn more about the early signs of cancer, has been applauded by doctors at trial stage. The impact of this tool is likely to be significant following recent concerns voiced by Cancer UK and reported in the media about delayed cancer diagnosis.

The tool was conceived by a research team from the Faculty of Health and Life Sciences at UWE Bristol led by principal lecturer Simon Messer, and developed in collaboration with Avon Somerset and Wiltshire Cancer Services (ASWCs) who commissioned the project as part of the National Awareness and Early Diagnosis Initiative.

The idea is that GPs can access GP Sim from their computer at a time that suits to fine tune their diagnostic skills.

GP Sim features virtual patients that simulate a series of consultations, each presenting a case in a clinical area where late cancer diagnosis is known to be a problem. The virtual patient is an avatar, with whom the GP can interact as if they were a real patient. In addition to the avatar patient interview the GP can also access online information such as X-rays, blood test results and other medical information which would have been accessible in the real situation to help the decision process. There is also an 'ask the expert' reference panel available alongside the interview that might determine and help the line of questioning they might pursue.

Simon Messer says, “GP Sim demonstrates how accurate questioning is integral to correct diagnosis. Coupled with careful analysis of medical records, clinical data and reference tools the tool mirrors a 'real patient consultation' thereby giving a safe environment to practice authentic decision making. We have a mix of cases, some with early signs of cancer and some without so that the consultation is not a foregone outcome.”

GP Sim has just undergone a rigorous analysis with the help of 72 GPs across Avon Somerset and Wiltshire who agreed to test the tool and feedback their experience of using it. The unanimous response has been very favourable.

Comments include:

“I liked the different options available to create your own consultation "journey". This made it more realistic”

“They were good cases, and they created quite realistic scenarios”

“The cases were very fair and common, the actors voices were very good, the user interface acceptable, the answers given by the patients had just the right degree of ambiguity that you get in practice (excellent choice of wording)”

“Real patient simulations to think about real life situations”

“It was nice to have positive feedback when you'd reached the right conclusion.”

Simon continues, “Of course with any new tool there are some glitches that we need to remedy and we want to scope the effectiveness with a larger group. The critique we have received so far has been fantastically useful”. The pilot feedback has been used to refine the set of virtual patient cases prior to general release via the ASWCs website to approximately 2000 GPs across the Southwest region. Simon adds, “There is a great opportunity for wider GP involvement, both within the Southwest and nationally, and we are looking at continuing with longitudinal research into the effects of the simulation on patient outcomes.”

The software used to create GP Sim has been developed by the Faculty's web development team led by Matt Cownie. Entitled UChoose it is designed to allow easy authoring and playback of scenarios for online case-based learning. It is capable of providing online simulation for education and training not only within the healthcare setting but also for any organisation that wishes to simulate authentic decision making in the workplace.

UChoose has impressed researchers from St Georges University, London, who lead the way in this area of medical training, and the UWE Bristol team have plans to collaborate with a view to developing more medical virtual learning programs in the future.

Medical insight and questions for the consulting rooms were provided by a team of six local GPs, recruited by ASWCs for the project, and include Dr Sarah Street who has recently won a GP Registrar Excellence Award from Severn Deanery for her work on the project.

Avon Somerset & Wiltshire Cancer Network has a history of supporting the development of on-line learning resources for GPs and welcomed the partnership with UWE to develop this innovative tool with DoH funding.

The virtual consultations present an ideal vehicle to raise awareness of importance of the earlier diagnosis of cancer, to increase confidence in referring patients as Two Week Wait referrals and to introduce tools which have been developed for use in Primary Care to improve the diagnosis of cancer. The results of the pilot show that the cancer learning objectives were achieved.

Elizabeth Lee Consultant in Public Health said, “This educational tool is a fantastic example of how development in academic institutions can be applied to practice. It is simple and interesting to use and will be a huge asset in giving GPs the confidence to identify suspected cancer.”

Dr Alison Wint Macmillan GP and Associate Medical Director for ASWCS, said, “It was a pleasure to work with a group of enthusiastic GPs to develop a set of scenarios which reflected real life General Practice. Through the pilot we have learnt how to improve on the writing of these scenarios so that future GP Sims will be better still.”